Using Theories of Behavior Change to Develop Interventions for Healthy Aging

Pica is associated with lower willingness to change negative habits of diet and exercise, inadequate lifestyle, and less healthful food consumption in dialysis

Background

In dialysis patients, on the one hand unwillingness to change negative lifestyle patterns is associated with worse nutritional status and unhealthy lifestyle, whereas on the other, pica may be highly prevalent. However, it is not known whether pica is associated with unwillingness to change negative lifestyle behaviors, as well as with consumption of different types of foods. This study aimed to investigate this issue.

Methods

This is a cross-sectional study in dialysis patients. Lifestyle was assessed using the self-administered Instrument to Measure Lifestyle Questionnaire (IMEVID). Pica diagnosis was established according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A food frequency questionnaire was performed and self-reported willingness to change was determined by a trans-theoretical model staging inventory.

Results

Compared with patients without pica, those with pica (particularly hard pica) had lower willingness to change unhealthy behavior in the case of diet (22% vs. 46% in precontemplation/contemplation stages, respectively) and exercise (43% vs. 62% in precontemplation/contemplation stages, respectively). Patients with hard pica had significantly (p < 0.05) lower scores in almost all dimensions of the lifestyle questionnaire than those in the no pica group: diet (23.9 vs. 26.8, respectively), physical activity (5.5 vs. 7, respectively), knowledge of disease (5.7 vs. 6.4, respectively), emotion management (6.6 vs. 8, respectively) and adherence to treatment (13.4 vs. 14.7, respectively), but not in the consumption of tobacco and alcohol. Compared to patients with no pica, those with hard pica ate vegetables and fruits less frequently, and dairy products, fried foods and soda more frequently.

Conclusions

Pica was more frequently observed in patients with lower willingness to change negative habits of diet and exercise, in those who had more unhealthy behaviors in diet, exercise and emotion management dimensions and adherence to treatment, as well as in those who ate less frequently healthful foods and more frequently unhealthy foods.

Value-based motivational strategies combined with technology to encourage a lifestyle that helps to prevent dementia

Lifestyles aimed at reducing dementia risk typically combine physical and cognitive training, nutritional adaptations, and, potentially, an augmentation in social interactions. Interventions at the population level are essential but should be complemented by individual efforts. For efficacy, lasting changes to an individual's lifestyle are needed, necessitating robust motivation and volition. Acting in accordance with one's values is assumed to be rewarding, leading to improved motivation and volition, and produces stable behaviour-outcome relationships. To this end, future preventive endeavours might first evaluate an individual's extant lifestyle, preferences, and values, including considerations of age-related changes to ensure these values remain a motivational source. Digital technology can support lifestyle goals and be targeted to support an individual's values. A digital platform could implement situation-specific, sensing-based feedback to alert users to a target situation (eg, opportunity for exercise) coupled with (smartphone-based) feedback on the extent of accomplished behavioural change to support individually set goals and facilitate their adjustment depending on whether these goals are achieved. This use of the motivational impetus of values, coupled with interpersonal techniques, such as motivational interviewing and SMART goal setting, in combination with sensor technology and just-in-time adaptive interventions, is assumed to hold high potential for dementia prevention.

Robot-Mediated Nudges for Workplace Health: Not a One-Size-Fits-All Modeling Problem

Prolonged sedentary behavior in the vast population of office and remote workers leads to increased cardiovascular and musculoskeletal health challenges, and existing solutions for encouraging breaks are either costly health coaches or notification systems that are easily ignored. A socially assistive robot (SAR) for promoting healthy workplace practices could provide the physical presence of a health coach along with the scalability of a notification system. To investigate the impact of such a system, we implemented a SAR as an alternative break-taking support solution and examined its impact on individual users' break-taking habits over relatively long-term deployments. We conducted an initial two-month-long study (N = 7) to begin to understand the robot's influence beyond the point of novelty, and we followed up with a week-long data collection (N = 14) to augment the dataset size. The resulting data was used to inform a robot behavior model and formulate possible methods of personalizing robot behaviors. We found that uninterrupted sitting time tended to decrease with our SAR intervention. During model formulation, we found participant responsiveness to the break-taking prompts could be classified into three archetypes and that archetype-specific adjustments to the general model led to improved system success. These results indicate that break-taking prompts are not a one-size-fits-all problem, and that even a small dataset can support model personalization for improving the success of assistive robotic systems.

Effects of Wisdom on Mental Health in Old Age: Exploring the Pathways Through Developmental Tasks Attainment and Self-Rated Health

Purpose

A number of studies indicate a relationship between wisdom and mental health in older adults, which can be explained by different pathways. However, the role of developmental task accomplishment, and of self-rated health in the relationships between wisdom and mental health in later life remain unclear. The aim of the current study is to explore the structure of the relationships between wisdom, developmental task attainment, self-rated health, and positive and negative mental health outcomes (viz. wellbeing and depressive symptoms) in older adults.

Methods

The study included 381 Polish older adults aged 60-86 (M= 67.33; SD = 5.08). The respondents completed the Personal Wellbeing Index, Geriatric Depression Scale, Three-Dimensional Wisdom Scale, Developmental Tasks Attainment Questionnaire for Seniors, self-rated health scale and sociodemographic survey.

Results

Three-dimensional wisdom, developmental task attainment and self-rated health scores were positive predictors of personal wellbeing and negative predictors of depressive symptoms in older adults. Structural equation modelling revealed that developmental tasks attainment and self-rated health partially mediated the relations between wisdom and mental health in older adults.

Conclusion

It can be assumed that wise older adults implement developmental tasks more efficiently and assess their subjective health more favorably, which may strengthen their personal wellbeing and prevent depression. The findings suggest that wisdom plays an important role in healthy aging.

Using the RE-AIM framework to evaluate physical activity-based fall prevention interventions in older adults with chronic conditions: A systematic review

Falls are a serious public health problem, especially for older adults with chronic conditions. The purpose of this systematic review was to evaluate the translational potential of physical activity-based balance interventions for older adults with common chronic conditions guided by the Reach, Effectiveness/Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. Databases were searched (2011-2021) to identify studies with physical activity-based fall prevention interventions for older adults with chronic conditions. Data were collected using the RE-AIM coding guide and Mixed Methods Appraisal Tool for evidence quality. The search yielded 122 articles, of which 14 distinct studies were included. The most reported RE-AIM dimensions across the studies were Reach (46.2%) and Implementation (40.5%), with Effectiveness/Efficacy (29.4%), Adoption (2.0%), and Maintenance (5.4%) being the least reported. Studies were largely conducted in controlled research environments with minimal staff involvement and without long-term follow-up periods. While studies found that physical activity-based programs were effective in improving balance, information on representativeness and adoption/maintenance of programs was lacking. Studies included sufficient details about the intervention (content, dosage, progression). External validity RE-AIM indicators were reported less frequently than internal validity indicators. The studies were of moderate quality overall. Studies often lacked information on indicators critical for understanding how to implement these programs. This review signals the need to investigate the translation of these interventions from controlled research settings to clinical settings to improve the public impact of fall prevention for this population.

Outcomes addressed in randomized controlled lifestyle intervention trials in community-dwelling older people with (sarcopenic) obesity-An evidence map

Obesity and sarcopenic obesity (SO) are characterized by excess body fat with or without low muscle mass affecting bio-psycho-social health, functioning, and subsequently quality of life in older adults. We mapped outcomes addressed in randomized controlled trials (RCTs) on lifestyle interventions in community-dwelling older people with (sarcopenic) obesity. Systematic searches in Medline, Embase, Cochrane Central, CINAHL, PsycInfo, Web of Science were conducted. Two reviewers independently performed screening and extracted data on outcomes, outcome domains, assessment methods, units, and measurement time. A bubble chart and heat maps were generated to visually display results. Fifty-four RCTs (7 in SO) reporting 464 outcomes in the outcome domains: physical function (n = 42), body composition/anthropometry (n = 120), biomarkers (n = 190), physiological (n = 30), psychological (n = 47), quality of life (n = 14), pain (n = 4), sleep (n = 2), medications (n = 3), and risk of adverse health events (n = 5) were included. Heterogeneity in terms of outcome definition, assessment methods, measurement units, and measurement times was found. Psychological and quality of life domains were investigated in a minority of studies. There is almost no information beyond 52 weeks. This evidence map is the first step of a harmonization process to improve comparability of RCTs in older people with (sarcopenic) obesity and facilitate the derivation of evidence-based clinical decisions.

Motivation and Healthy Aging: A Heuristic Model

Building on the seminal definition of "healthy aging" by the World Health Organization (WHO, 2015; 2020), we present a model of motivation and healthy aging that is aimed at identifying the central psychological constructs and processes for understanding what older persons value, and how they can attain and maintain these valued aspects of their lives. This model places goals at its center, and then proceeds from motivational processes of goal setting, pursuit, and disengagement, to contextual factors (cultural, social, technological, physical, organizational, and life-history related aspects) that provide opportunities and constraints to the healthy aging of individuals. We briefly introduce each of these constructs and processes, thereby setting the scene for the articles included in this supplement that each address one or more of the facets of the heuristic model of motivation and healthy aging.